Provider Demographics
NPI:1821581968
Name:NETTO, JENNIFER ROBYN (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROBYN
Last Name:NETTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E GRAND CAYMAN DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6776
Mailing Address - Country:US
Mailing Address - Phone:619-410-3119
Mailing Address - Fax:
Practice Address - Street 1:820 E GRAND CAYMAN DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-6776
Practice Address - Country:US
Practice Address - Phone:619-410-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5675875-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical